A prospective randomized clinical trial comparing 150 IU and 225 IU of recombinant follicle-stimulating hormone (Gonal-F*) in a fixed-dose regimen for controlled ovarian stimulation in in vitro fertilization treatment

Yong, Peter; Brett, Sandra; Baird, D. T.; Thong, K.J.

doi:10.1016/s0015-0282(02)04583-1

Cited by 64 publications

(32 citation statements)

References 34 publications

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“…Such a study has never been performed. The randomized studies that have been performed on different starting doses in IVF stimulation showed that more oocytes were retrieved in young patients who received a higher dose of gonadotropins, but not in older patients (33,34). The results of the present study suggest that increasing the dose might only be beneficial in young poor responders when the poor response is unexpected.…”

Section: Fertility and Sterilitymentioning

confidence: 50%

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

Klinkert

Broekmans

Looman

et al. 2004

Fertility and Sterility

102

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Objective: To calculate the cumulative ongoing pregnancy rate in patients with a poor response in their first IVF cycle. Design: Retrospective cohort study. Setting: In vitro fertilization unit of a university hospital. Patient(s): Two hundred twenty-five women who experienced a poor response in their first IVF or intracytoplasmic sperm injection cycle. These patients were divided into 64 expected (aged Ն41 years and/or elevated FSH level) and 161 unexpected poor responders (aged Ͻ41 years and FSH level not elevated). Intervention(s):In vitro fertilization treatment with a long-suppression protocol with FSH-urofollitropin or recombinant FSH. Main Outcome Measure(s): Cumulative ongoing pregnancy rate. This rate was calculated in two ways to correct for dropouts: pessimistic (zero chance of pregnancy for the dropouts) and optimistic (the same chance for the dropouts as for patients who continued). Result(s):The cumulative ongoing pregnancy rate of women with an unexpected poor response in the first cycle was 37% (pessimistic) to 47% (optimistic) after three cycles. Women with an expected poor response had a cumulative ongoing pregnancy rate of 16% (pessimistic) to 19% (optimistic) after 3 cycles. Sixty-four percent of the unexpected poor responders and 31% of the expected poor responders had a normal response in the second cycle, most of them after receiving a higher dose of gonadotropins. Conclusion(s):Most patients with an unexpected poor response in the first cycle had a normal response in the second cycle, leading to an acceptable cumulative ongoing pregnancy rate after three cycles. Patients with an expected poor response in the first cycle should be advised to withdraw from treatment after the first cycle because of a poor prognosis. (Fertil Steril 2004;81:1247Ϫ53.

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Section: Fertility and Sterilitymentioning

confidence: 50%

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

Klinkert

Broekmans

Looman

et al. 2004

Fertility and Sterility

102

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“…In this regard, by taking into account the total stimulation dose hence adjusting for the effect of dose manipulation, the value of OSI would still be high despite the oocyte number being not excessive. On the other hand, in expected poor ovarian responders, maximal high dose stimulation is usually adopted, although some studies have argued that increments of daily doses beyond 225 IU would not further increase the number of oocytes [8,9]. Overzealous increase in the stimulation dose in such circumstances may thus a No pituitary down-regulation was used in one subject with hypogonadotrophic hypogonadism b Applicable to subjects who had a second IVF cycle subsequent to the index first cycle exaggerate the reduction in OSI but this depends on the threshold one takes to interpret the OSI value.…”

Section: Discussionmentioning

confidence: 99%

Ovarian sensitivity index is a better measure of ovarian responsiveness to gonadotrophin stimulation than the number of oocytes during in-vitro fertilization treatment

Lee

et al. 2013

J Assist Reprod Genet

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Purpose To validate the use of the ovarian sensitivity index (OSI) as a measure of ovarian response during in-vitro fertilization (IVF) treatment. Methods This is a retrospective study carried out in an assisted reproduction unit in a teaching hospital. We analysed data from 2,556 women undergoing the first IVF cycle between 2002 and 2009. OSI was calculated as the number of retrieved oocytes divided by total dose of FSH administered (per 1,000 IU). Its correlation to other parameters of ovarian response was compared to that of the oocyte number. Results The correlation coefficients of OSI with age, AFC, AMH, total dose of gonadotrophin, average daily dose of gonadotrophin and duration of stimulation were significantly higher than that of oocyte number with these respective parameters. OSI demonstrated a higher intraclass correlation coefficient (ICC) than the oocyte number when comparing the two parameters across the first and second stimulated IVF cycles. Conclusions OSI is a better measure of ovarian responsiveness to gonadotrophin stimulation than the oocyte number, and is particularly useful when different subjects are treated with different stimulation regimens which would have confounding effect on the oocyte number.

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“…As women 36 years and older were routinely placed on 200-300 IU/ day rFSH, it was unlikely that this group would gain further from an upward dose adjustment. Secondly, previous studies had shown that only women aged less than 36 years, not older women, produced more oocytes during COH if their starting dose of FSH stimulation was increased beyond 150 IU/day [26,28].…”

Section: Methodsmentioning

confidence: 99%

“…Firstly, previous studies have shown that the ceiling for maximal effect of gonadotrophin stimulation is approximately 200-300 IU/day [22,23]. Only upward adjustments of the starting dose below this 200 IU/day ceiling have been shown to improve IVF oocyte yields [3,[23][24][25][26][27]. As women 36 years and older were routinely placed on 200-300 IU/ day rFSH, it was unlikely that this group would gain further from an upward dose adjustment.…”

Section: Methodsmentioning

confidence: 99%

“…A prospective randomized control trial that compared a standard starting dose of gonadotrophins in the first cycle of IVF (150 IU/day FSH) with an individualized starting dose (100-250 IU/day) based on such a predictive normogram (age, antral follicle count, ovary volume , Doppler score and smoking status) confirmed that an individualized starting dose was more effective at achieving an "ideal response" (5-14 oocytes) than a standard starting dose (77.1% v 65.6% ideal response, p < 0.05). While some studies have shown a positive benefit from increasing the starting dose of gonadotrophin [3,5], many others have not shown a benefit [4,23,26]. Therefore, it is presently uncertain if upward adjustment of gonadotrophin starting dose has any clinical value.…”

Section: Introductionmentioning

confidence: 99%

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Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Lekamge

Lane

Gilchrist³

et al. 2008

J Assist Reprod Genet

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Purpose This retrospective study was carried out to evaluate whether increasing the starting dose of FSH stimulation above the standard dose of 150 IU/day in patients with low predicted ovarian reserve can improve IVF outcomes. Method A total of 122 women aged less than 36 years in their first cycle of IVF were identified as having likely low ovarian reserve based on a serum AMH measurement below 14 pmol/l. Thirty five women were administered the standard dose of 150 IU/day FSH, while the remaining 87 received a higher starting dose (200-300 IU/day FSH). There were no significant differences in age, BMI, antral follicle count, serum AMH, FSH or aetiology of infertility between the two dose groups.Results No significant improvement in oocyte and embryo yield or pregnancy rates was observed following an upward adjustment of FSH starting dose. While increasing the dose of FSH above 150 IU/day did not produce any adverse events such as OHSS, it did consume an extra 1,100 IU of FSH per IVF cycle. ConclusionThe upward FSH dose adjustment in anticipation of low ovarian reserve can not be advocated as it is both expensive and of no proven clinical value.

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A prospective randomized clinical trial comparing 150 IU and 225 IU of recombinant follicle-stimulating hormone (Gonal-F*) in a fixed-dose regimen for controlled ovarian stimulation in in vitro fertilization treatment

Cited by 64 publications

References 34 publications

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

A poor response in the first in vitro fertilization cycle is not necessarily related to a poor prognosis in subsequent cycles

Ovarian sensitivity index is a better measure of ovarian responsiveness to gonadotrophin stimulation than the number of oocytes during in-vitro fertilization treatment

Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

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